Ayeeshia’s mother Kathryn Smith and stepfather Matthew Rigby, aged 22, both deny murdering the toddler at their flat in Burton-upon-Trent in Staffordshire on May 1.

The youngster, who had been known to social services since birth in June 2012, put on a healthy amount of weight only after being taken into foster care around the time of her first birthday the jury was today told.

She was returned to Smith’s full-time care in October 2013, despite the foster family recording ‘concerns the (feeding) routines were not being kept’ by the 23-year-old mother during contact visits.

But the youngster shed almost a kilo in weight between a hospital admission in February 2014, after she suffered a fit in April when she was seen by a health visitor.

The drop in weight went unnoticed by health workers.

Jurors were told an ambulance had to be called to the family home on February 3 last year, after the girl suffered a seizure at home and later had to be taken to Burton’s Queens Hospital.

The episode was diagnosed by the doctors as a ‘febrile fit’, however today the prosecution’s paediatric medical expert Dr Kathryn Ward said there was no evidence to have supported that diagnosis.

Describing the seizure as possible evidence of what doctors call an ‘apparent life-threatening episode’, she concluded it was ‘probable’ to link the 999 call incident to a deliberate head injury.

She added: ‘This was clearly a significant event in the child’s life and given the timing of the (subsequent) post-mortem and the intracranial findings, I think it’s possible and indeed probable that the event on 3rd February was associated with a non-accidental head injury.”

The Crown’s QC Christopher Hotten asked Dr Ward: ‘Could you find any evidence in Ayeeshia’s medical records that the possibility of non-accidental injury was considered on 3rd February?’

Dr Ward said she could find no evidence it was ever considered by the hospital doctors, adding that if it had been it is likely a CT scan of the head would have been ordered with an examination of the girl’s eyes for retinal bleeds and a full skeletal survey to check for any bone fractures or breaks associated with inflicted injury.

On March 29 2014, Ayeeshia was again in Burton hospital with a cut to the inside of her lower lip described as ‘a significant injury’, which was so severe doctors discussed transferring her for specialist treatment in Birmingham.

Dr Ward said: ‘An injury to the lip can occur as a result of an accidental fall, such that the child actually bites their own lip with their teeth, but that would have to be a very significant and forceful fall.

‘Alternatively, it can be caused by an inflicted blow to the lip – it’s not possible to be absolutely clear which is the cause.’

Of the fatal injuries sustained at the family home in Britannia Drive, Burton, on May 1, the consultant said: ‘There was no history of this child suffering the sort of trauma; like a severe road traffic accident; or the child falling several storeys from a building.

‘In order to sustain accidental trauma causing this type of injury, it has to be extreme trauma. This is not the sort of injury that occurs in a household on a day to day basis.’

She was asked about a large patch of bruising on the youngster’s back which Smith and Rigby have alleged was suffered when she fell off the potty, but Dr Ward said she would only expect a ‘small’ bruise from such an incident.

Then asked about the number of injuries found on the child, Dr Ward added: ‘While one can’t be clear as to whether these were definitely inflicted injuries or not, there was certainly a concerning pattern of a child presenting with significant injury.’

Smith and Rigby deny causing or allowing the death of a child and cruelty to a youngster under 16. The trial continues.